Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted

Monitoraggio dell'antitrombina III in chirurgia generale [Monitoring of antithrombin III in general surgery]

The authors studied the effects of surgery on hemocoagulation parameters (PT, PTT, PLT, Fibrinogen, AT III). 30 patients, undergoing extrahepatic surgery were observed. Measurements were performed before, during and immediately after procedure, and 24 hs and 48 hs later. Results showed a significant drop of AT III activity (p < 0.05) throughout the surgical procedure with a prompt reversal to normal values right after the end of it. Fibrinogen values continuously increased from the end of surgery (compared to intra-op values) (p < 0.05) up to 48 hs (p < 0.01). PTT values decreased at the end of surgery (p < 0.05) and returned to normal during the following 24 hs. No thromboembolic and hemorrhagic complications were observed during the postoperative phase, with all patients being discharged after surgical resolution of pathologies. In conclusion accurate monitoring of hemocoagulation parameters (especially AT III) seems to be useful in order to prevent thromboembolic and/or hemorrhagic complications during and after surgery.The authors studied the effects of surgery on hemocoagulation parameters (PT, PTT, PLT, Fibrinogen, AT III). 30 patients, undergoing extrahepatic surgery were observed. Measurements were performed before, during and immediately after procedure, and 24 hs and 48 hs later. Results showed a significant drop of AT III activity (p < 0.05) throughout the surgical procedure with a prompt reversal to normal values right after the end of it. Fibrinogen values continuously increased from the end of surgery (compared to intra-op values) (p < 0.05) up to 48 hs (p < 0.01). PTT values decreased at the end of surgery (p < 0.05) and returned to normal during the following 24 hs. No thromboembolic and hemorrhagic complications were observed during the postoperative phase, with all patients being discharged after surgical resolution of pathologies. In conclusion accurate monitoring of hemocoagulation parameters (especially AT III) seems to be useful in order to prevent thromboembolic and/or hemorrhagic complications during and after surgery

Peripheral arterial disease has a strong impact on cardiovascular outcome in patients with acute coronary syndromes: from the START Antiplatelet registry

Background: Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-life setting. Methods: START-ANTIPLATELET is a multicenter registry enrolling ACS patient. Baseline clinical characteristics and treatment at discharge were recorded and follow-up was repeated at 6-months and 1-year. PAD was defined as intermittent claudication and/or previous revascularization. Results: Among 1442 patients enrolled, 103 (7.1%) had PAD. PAD patients were older (71.8 ± 10.6vs66.2 ± 12.6 yrs., p < 0.0001), more frequently hypertensive (90.3vs68.6%, p< 0.0001), hypercholesterolemic (66vs52%, p= 0.037), diabetic (51.5vs24%, p= 0.0001), obese (28.2vs19.3%, p= 0.029) and with previous TIA (7.8vs2.8%, p= 0.005) or stroke (11.7vs3.1%, p< 0.0001). Clinical presentation and acute treatment were similar in non-PAD and PAD patients, but the latter were discharged significantly less frequently on dual antiplatelet therapy (DAPT) (68.9vs85%, p= 0.005). After a median follow-up time of 11.1 months, major cardio/cerebrovascular event-free survival [MACCE, including cardiovascular death, MI, TIA and stroke, target-vessel revascularization (TVR) and major arterial ischemic events] was significantly shorter (9.0vs11.2 months, p= 0.02; HR 3.2, 2.4–8.4) in PAD patients and net adverse cardiovascular events (NACE = MACCE plus major hemorrhages) were significantly more frequent (19.1%vs10.5%, p = 0.049). Conclusions: PAD identifies a subgroup of ACS patients at significantly increased cardiovascular risk, but these patients tend to be undertreated. Patients admitted for ACS should be screened for PAD and optimal medical therapy at discharge should be implemented

Corpo Futuro. Il corpo umano tra tecnologie, comunicazione e moda

I confini del corpo umano non sono mai stati tracciati in modo preciso. E oggi lo sono meno che mai per l'intricata commistione di artificiale e naturale. Il corpo ha perci\uf2 opposto poca resistenza al progressivo avvicinamento delle tecnologie e altrettanto poca resistenza alla sua penetrazione da parte di esso. La rapidit\ue0 assunta oggi da tale processo, carico di opportunit\ue0 ma anche di pericoli per gli esseri umani, rischia di ostacolare la consapevolezza collettiva di ci\uf2 che sta accadendo al corpo. Per questo motivo studiosi di varie discipline, provenienze e culture si sono trovati a discutere insieme questo tema nel convegno internazionale "Il corpo umano tra tecnologie, comunicazione e moda" (Triennale di Milano, 11-12 gennaio 2001), i cui lavori sono riportati in questo volume. La prima area affrontata \ue8 quella delle tecnologie comunicative (cellulare, computer portatile, cerca persone), che hanno esteso i confini del nostro corpo. Esse si sono arrampicate sulla sua superficie senza trovare ancora una collocazione stabile, ponendosi talvolta in conflitto con l'estetica dell'abbigliamento e con la percezione sociale ed etica del corpo stesso. La seconda area riguarda il mutamento tecnologico nella moda, che coinvolge in primo luogo il tessuto e i materiali, che diventano "intelligenti". L'"intelligenza" che fino a ieri distingueva gli esseri umani dalle altre entit\ue0 dell'ordine cosmico, nella sua veste officiale \ue8 migrata ovunque, antropoformizzando l'ambiente. Il corpo con i suoi miti e modelli di bellezza e la moda con le sue politiche estetiche non potevano che contaminare anche la tecnologia comunicativa, che si trasforma cos\uec da portatile a indossabile. La terza area si occupa del ruolo delle tecnologie nell'ambito del benessere e della salute, sia in un'ottica terapeutica e diagnostica sia nel campo del miglioramento della qualit\ue0 della vita. Questo ruolo va visto in senso lato, cio\ue8 nella sua estensione alla quotidianit\ue0, che procede anche mediante le tecnologie integrate nell'abitazione (domotica) e nell'ambiente urbano. Il dibattito ha cercato di comprendere quali sono le linee di tendenza espresse dalle tecnologie comunicative e, allo stesso tempo, dalla moda, dal design e dall'arte nell'impatto con il corpo, che cosa l'essere umano acquisisce e/o perde con la penetrazione delle tecnologie nel corpo, quali sono i possibili rischi (anomia, perdita di identit\ue0, strategie di controllo sociale e individuale). E, infine, che cosa ci sta dicendo il corpo stesso